Advances and surgical therapeutics in the management of immunoistochemical CD-117 positive subepithelial lesions of the gastrointestinal tract

Gastrointestinal stromal tumor (GIST) is the term for a specific, immunohistochemically KIT-positive (90% of KIT mutations involve exon 11) subepithelial neoplasm of the gastrointestinal tract and abdomen. Neoadjuvant therapy can be effectively used for the treatment of metastatic and recurrent GIST or when the surgery can’t be radical at the first time. Symptoms of GIST are gastrointestinal bleeding, gastric pain, intestinal obstruction, hemoperitoneum because of tumor rupture. Most of GISTs are detected incidentally (CT scan, endoscopy for other reasons) and they are less than 5 cm in size. As is known, surgical resection is always the first therapeutic option if R 0 can be achieved. Post-therapy surgery with Gleevec® is the choice in metastatic, recurrent GIST and in situations where due to the site or size, surgery may not prove radical or may jeopardise the patient’s quality of life. Borderline cases should be discussed collectively in centres with a radiologist, oncologist and surgeon.